Frontotemporal Dementia. Eneida Mioshi

Transcription

1 Activities of Daily Living in Frontotemporal Dementia Eneida Mioshi

2 Frontotemporal dementia FTD Behavioural variant Bv-FTD Language variants (progressive aphasia) Semantic Dementia Progressive Non-Fluent Aphasia

3 Outline Objectives Definition iti of Activities iti of Daily Living i (ADLs) Methods Results General Strategies

4 Outline Objectives Definition iti of Activities iti of Daily Living i (ADLs) Methods Results General Strategies

5 Objectives Present the patterns of activity dysfunction across the three FTD variants P t t t i f dd i t Present strategies for addressing most common problems

6 Outline Objectives Definition iti of Activities iti of Daily Living i (ADLs) Methods Results

7 BADLs IADLs

8 ADLs = Activities of daily living BADLs = IADLs = basic instrumental

9 Activity performance: stages Initiation Planning Execution

10 Activity performance I P E Frontal lobes Physical Frontal lobes Lack of motivation Planning difficulties Difficulties in problem solving Misjudgement

11 Outline Objectives Definition iti of Activities iti of Daily Living i (ADLs) Methods Results General Strategies

12 Methods Cross sectional study: n = 59 bv-ftd (15), SD (15), PNFA (10), AD (19) Age: 64.6; 6; Edu: 11.6 y; duration: 4.9y Outpatients of Cambridge Clinics Disability Assessment of Dementia

13 Outline Objectives Definition iti of Activities iti of Daily Living i (ADLs) Methods Results General Strategies

14 Instrumental ADLs 100% Distribu ution of patients 80% 60% 40% 20% 0% PNFA Semantic Dementia bv-ftd AD No change Marginal to mild impairment Moderate to severe Severe to very severe impairment Mioshi et al, 2007

15 Instrumental activities Leve el of ability Meal prep. Teleph. Outing Fin. and corr. Medic. Leis. and Hous. FTD PNFA SD

16 Basic ADLs 100% 80% Distrib bution of patien nts 60% 40% 20% 0% PNFA Semantic bv-ftd AD Dementia No change Moderate to severe Marginal to mild impairment Severe to very severe impairment Mioshi et al, 2007

17 Basic activities Leve el of ability Leve el of ability Hygiene Dressing Continence Eating FTD PNFA SD

18 Outline Objectives Definition iti of Activities iti of Daily Living i (ADLs) Methods Results General Strategies

19 General Strategies Facilitate performance Prevent distress Keep patient as active as possible Focus on abilities

20 Meal preparation Multi tasking difficulties: breaking Multi tasking difficulties: breaking down in single steps

21 Using the telephone Not passing on messages: answering machine; turning the phone down; diverting calls; asking friends to call mobile M ki i ll it i Making excessive calls: monitoring outgoing calls

22 Driving Lack of judgment; impulsivity: have a driving assessment arranged by a third party

23 Shopping Difficulties in understanding name Difficulties in understanding name of products: show products; vegetables

24 Finances Overspending: reduce access to one account; contact t branch manager Multiple cards: keep one pin number only

25 Correspondence Intercepting mail: get a post box; have mail redirected to a family member

26 Medications Refusal: discuss with doctor and Refusal: discuss with doctor and pharmacist alternative formula.

27 Housechores Planning difficulties: break down in single steps

28 Hygiene Planning difficulties: break down in single steps Lack of initiative: routine; association with an external event

29 Dressing Wearing same clothes: have a set sorted for him/her; hide dirty laundry in washing machine

30 Toilet Accidents: avoid liquids after Accidents: avoid liquids after dinner

31 Eating Lack of manners: warn friends in advance Overeating: take dishes from the Overeating: take dishes from the table

32 Take home message FTD patients are markedly impaired in everyday y life SD and PNFA present with problems beyond language In bv-ftd, BADLs are more affected than in AD and language variants Caregiver support is fundamental

33 Why? Patient Caregiver Ati Active Sharing Participation Time Confidence Stress

34 Acknowledgements All patients and their families John Hodges Kate Dawson